| NPI | 1730573585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS MAZZELLA Owner 352-512-0222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME110316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME110316) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2015-03-24 |